Norman E. Rosenthal's Blog, page 6
November 7, 2012
Transcendental Meditation: A Promising Remedy for Workplace Stress
It is a matter of broad consensus that stress in the workplace has reached epidemic proportions. So bad has the problem become, that stress is now a more common cause of long-term sick leave than stroke, heart attack, cancer and back problems, according to a report by the Chartered Institute of Personnel and Development. Workplace stress has been labeled “The Black Death of the 21st Century.”
Common causes of workplace stress include excessive workload, poor management style, workplace restructuring, and problems at home. As the great pioneer in stress research, Hans Selye, observed, it is not the stress itself, but how we react to it that affects its impact on our bodies and minds. During economic downturns, such as we are facing at present, ordinary workplace difficulties become more stressful because workers feel insecure about their job stability and fearful of losing their job, especially because it is often difficult to find a new one.
Stress takes a toll on both body and mind. It is a major contributor to cardiovascular disease, the number one killer in developed countries. In addition, it predisposes to anxiety and depression, both enormous mental health problems. For those who of us who are concerned about performance and productivity in the workplace, it is crucial to find remedies for toxic work stresses. Such remedies will also lead to healthier workers, with fewer days off sick, lower health care bills, and extra years of productivity. There are many available “stress management” programs. In this piece, I make the case why a simple but powerful technique, Transcendental Meditation (TM), should rise to the top of the list.
Why Transcendental Meditation?
TM is a simple technique of meditation, taught in a standardized one-on-one way over the course of a week. The instructor gives the student a mantra, along with instructions as to how to use it. TM is simple to learn and easy to practice. Ideally, the practitioner should sit comfortably with eyes closed for two sessions of 20 minutes each per day.
As a researcher and physician, I have been impressed by the scope and extent of research data supporting the benefits of TM (over 330 peer-reviewed articles to date). Much of this research has a direct bearing on the damaging physical effects of stress. For example, controlled studies have shown multiple physical benefits of TM versus controlled treatments, such as: (1) Reduction in blood pressure that is both statistically and clinically meaningful; (2) Actual reversal of arterial narrowing in the carotid arteries which carry blood to the brain; (3) increased longevity over the course of years (a finding that has been replicated). From the point of physical well- being alone, TM is worth practicing.
But there is more. A meta-analysis of 146 treatment groups found that TM reduced anxiety to a greater extent than other approaches. Likewise, five controlled studies in people not recruited specifically for depression showed that practicing TM was followed by a reduction in depression symptoms to a greater extent than control treatments. Evidence suggests that the improved blood pressure seen with TM is mediated by decreased anxiety. In other words, TM seems to be acting as a shock absorber, decreasing the impact of stress on both mind and body.
No other “stress management technique” has anywhere close to this amount of hard data in support of its claims to reduce stress.
Beyond its effects on stress reduction, TM has also been shown in numerous studies to improve levels of self-actualization – a term used to describe the need for people to be the best they can be. This benefit may result from the direct effects of TM on the brain, which include increased brain coherence. Brain coherence means that the firing patterns in different parts of the brain correspond to one another. Higher levels of brain coherence have been associated with higher levels of performance, both in businessmen and athletes.
How do the benefits of Transcendental Meditation play out in the workplace?
To begin, let us hear from two leading business people, who are regular meditators and have praised TM’s benefits: Ray Dalio, founder of Bridgewater, the largest hedge fund in the world; and Oprah Winfrey, media icon and CEO of Harpo Studios. Dalio has said that TM has helped him make up for lost sleep and has made his patterns of thinking “more centered and creative.” With TM, he says, “Life got better and everything became easier.” He reports dealing with challenges in a calm, clear-headed way, which allows him to put things in perspective – “like a ninja.” Winfrey was so pleased with her own personal experience with TM that she provided TM training free of charge to all members of her organization. Her observations: “You can’t imagine what has happened. People are sleeping better. People have better relationships. People interact with other people better. It’s been fantastic.”
Many other CEOs and business leaders have reported similar benefits in their organizations. How can we understand these extraordinary transformations?
How can Transcendental Meditation help work-stress?
Let me count the ways. TM results in:
Increased brain coherence that is associated with increased levels of accomplishment
Reduced stress responses producing more clarity, less reactivity, and better decision-making. As Dalio put it, “I am centered – not hijacked by emotion”
Enhanced creativity, even with aging
Better physical health
Greater harmony
At every level of organization, TM promotes harmony. This applies within the mind of the meditator, between mind and body, and in groups. Once the meditator learns the practice and develops the habit, the 40 minutes spent per day is rapidly repaid in the form of improved performance and efficiency. How wonderful it is to think that this quiet twice-daily practice might turn out to be a remedy for “The Black Death of the 21st century!”
• Norman E. Rosenthal, M.D is author of Transcendence: Healing and Transformation Through Transcendental Meditation (Hay House, 2012).
This article was originally published by Decision Magazine, in the Wellness section of the Summer 2012 issue.
September 26, 2012
How to Stop Your Emotions from Controlling You
Writer Mary Wollstonecraft said, “When we feel deeply, we reason profoundly.” These are wise words for those of us trying to understand the intelligence of our emotions. This blog post provides tips and suggestions on how to stop your emotions from controlling you.
Science has now shown that certain parts of our brain specialize in processing emotional information; these parts are somewhat distinct from those responsible for intellect. Further, the different regions may not always work in concert; we may experience feelings and not understand why. Modern neuroscience has validated classical analytic theories about the power of unconscious feelings to drive our actions, 
sometimes without ever surfacing into our awareness.
Pascal famously said that “the heart has a reason that reason cannot know,” anticipating both Freud and those modern neuroscientists who have demonstrated the existence of unconscious feelings. But Pascal underestimated the power of the human intellect to comprehend mysterious and elusive things, feelings included. Now that thousands of scientists are focusing their intellect on the mysteries of emotion, reason is finally starting to comprehend the reasons of the heart.
Human beings have highly developed reasoning centers housed in the neocortex (the most recently evolved part of the brain), which offer the ability to experience complex emotions, such as: love, vengeance and anger. But the capacity to experience these complex emotions profoundly act on them rationally and in a measured way is a skill worth developing – one that requires patience, practice, contemplation and reflection.
Nine strategies for helping to stop your emotions from controlling you:
1) Become a good judge of your own mood: Just as you weigh yourself when you begin a diet, then track your weight as you progress, so you should learn to track your mood.
2) Exercise in moderation
3) Take control of those aspects of your life that you can: Just knowing that you have some ability to improve your life can help pacify intense emotions. Even if you choose to stay in difficult situations, such as a bad marriage or job, you have taken some steps to regain control.
4) Tackle stress by practicing relaxation, meditation and yoga
5) Seek out social support systems
6) Selectively consider appropriate herbs, nutrients and supplements
7) Attend to your sleep and stay rested
8) Alter your environmental light, especially when days are short and dark, which can be conducive to depression.
9) Avoid alcohol and beware of drugs, substances that can give you the illusion of control in the short run, but aggravate the situation down the line.
Finally, enjoy and appreciate your feelings. It is by recognizing and thinking deeply about our emotions that we are able to reach the most important decisions of our lives.
Wishing you Light and Transcendence,
Norman
Additional Articles/resources You Might Enjoy:
Seven Tell-Tale Signs of Depression in a Friend or Loved One
Emotional Intelligence: 10 Ways to Enhance Yours
September 12, 2012
Transcendental Meditation Visualized [Infographic]
I wrote Transcendence: Healing and Transformation Through Transcendental Meditation (Tarcher-Penguin,2011) because I simply had to. Transcendental Meditation (TM) had done so much good both for my patients and myself, had such strong research backing, and was so pleasant and easy to do that I felt the urge to share these experiences as seen through the eyes of a doctor, scientist and TM practitioner. The infographic below is brought to you as a resource and extension of the book “Transcendence,” which features some of the main points about Transcendental Meditation that I highlighted in the book.
If you find this graphic useful please feel free to embed it on your website or blog by using the embed code at the bottom of the infographic.
Transcendental Meditation Visualized – Infographic
The hardcover version of Transcendence contained so many descriptions of people who had dramatic experiences during meditation that I wanted to reassure those who did not have these four-star special effects that they could still derive tremendous benefits from the practice. Here’s how I end the new chapter.
For most people . . . myself included, the effects of TM are subtle and gradual, but cumulative. Yet as the rippling waters of a stream can smooth the edges of the sharpest stone, so can the gentle flow of meditation alter the shape and contours of a person’s life.
I hope that you enjoy the paperback version of Transcendence, and most of all, that you benefit from its contents.
Wishing you Light and Transcendence,
Norman
Feel Free to Embed the Above Infographic Image on Your Site:
This infographic was designed by Galaxy Ninja.
September 5, 2012
Press Kit
Hello Friends:
I created this page to help aggregate content that I thought would be useful for different media, bloggers and list owners.
Do you have a magazine, column, blog, TV show, radio show, or mailing list? Would you like to do an interview, feature, or post an excerpt from the book? Please email drnormrosenthal@gmail.com with your name, phone number, type of media and size of audience, also please place MEDIA INQUIRY as your email subject.
Wishing you Light and Transcendence,
Norman
—————————————————————
BIO: Dr. Norman E. Rosenthal is the world-renowned psychiatrist and author whose research in describing seasonal affective disorder (SAD) and pioneering the use of light therapy has helped millions of people.
His latest book, New York Times best-seller Transcendence is being released in paperback form (September 2012) with a new afterword by the author detailing the latest developments in Transcendental Meditation. At the same time, his book Winter Blues: Everything You Need to Know to Beat SAD, which the New York Times called “a landmark book” is being released in its revised and updated fourth edition, which includes a chapter on Meditation for the Winter Blues. Full Bio ->
I. Transcendence: Healing and Transformation Through Transcendental Meditation (Tarcher-Penguin, 2011)
A Sneak Peek at the Paperback Version of Transcendence ->
Norman Rosenthal Press Coverage ->
A Transcendental Cure for Post-Traumatic Stress
Transcending a Different Type of PTSD — Helping Children of the Night
Dr. Rosenthal’s Current Events/Speaking Engagements ->
Invite Norman Rosenthal to Speak at Your Next Event ->
My Reddit AMA (3 hour Q & A, with over 1,500 comments) ->
Transcendence 2012 Nautilus Book Award ->
Transcendence – Table of Contents ->
Transcendence Synopsis +
Norman Rosenthal, M.D., a twenty-year researcher at the National Institute of Mental Health and the psychiatrist who pioneered the study of seasonal affective disorder (SAD), brings us the most important book on Transcendental Meditation since the Maharishi Mahesh Yogi’s Science of Being and Art of Living–and one of this generation’s most significant works on achieving greater physical and mental health and wellness.
Transcendence demystifies the practice and benefits of Transcendental Meditation for a general audience who may have heard about the technique but do not necessarily know what it is or what they stand to gain, physically and emotionally, from its daily practice. Rosenthal clearly and practically explains the basic ideas behind Transcendental Meditation: It is a non religious practice that involves sitting comfortably for twenty minutes twice a day, while using a silent mantra, or nonverbal sound, to attain a profound state of aware relaxation.
Rosenthal draws upon experience from the lives of his patients and a wealth of clinical research amassed on TM over the past generation (some 240 peer-reviewed published articles) to provide the fullest and most accessible book ever on the broad range of benefits of this remarkably simple method–from relief of anxiety, stress, and depression to new hope for those suffering from addiction, attention deficit disorder, or post-traumatic stress disorder.
In exclusive celebrity interviews, stars like Paul Mccartney, Ringo Starr, Martin Scorsese, Russell Brand, Laura Dern, Moby, and David Lynch openly discuss their meditation and the benefits they have experienced. McCartney and Starr talk about TM and the Maharishi publicly for the first time in more than thirty years. Transcendence also features stories from everyday people–ranging from veterans to students coping with anxiety disorders–highlighting how TM has helped them achieve more fulfilling lives.
Praise for Transcendence +
“Dr. Norman Rosenthal’s Transcendence is the best-ever book on Transcendental Meditation: accessible and substantive, engaging and scientific, practical and profound. A very enjoyable read that can change your life, for good.” - David Lynch, Filmmaker
“Transcendence is a profoundly important book on a topic that you need to know more about… This will become the go-to book for those searching for the wisdom within meditation.” - Mehemet C. OZ, M.D.
“I have been meditating for over 10 years, and I have found Transcendence to be a uniquely compelling introduction to the art and science of Transcendental Meditation. Dr. Norman Rosenthal’s book will propel TM into the mainstream where it belongs.” - Russell Simmons, Entrepreneur
“Whether your troubles are deep or you simply know life could be better and healthier, read this book.” - Candy Crowley, CNN AnchorTranscendence: Publication Details +
JEREMY P. TARCHER/PENGUIN
Published by the Penguin Group
Penguin Group (USA) Inc., 375 Hudson Street, New York, New York 10014, USA
Penguin Books Ltd, Registered Offices: 80 Strand, London WC2R 0RL, England
Copyright © 2011 by Norman E. Rosenthal, M.D.
Rosenthal, Norman E.
Transcendence: healing and transformation through transcendental meditation /
Norman E. Rosenthal.
p. cm.
ISBN 978-1-58542-873-1
II. Winter Blues Everything You Need to Know to Beat Seasonal Affective Disorder
Introduction to the Fourth Edition of
Winter Blues
Norman Rosenthal Press Coverage ->
How to Beat Seasonal Affective Disorder and The Winter Blues [Infographic] ->
Winter Blues – Table of Contents +
Contents
Acknowledgments ix
Preface xi
Part I
Seasonal Syndromes
ONE Introduction: Discovering SAD 3
TWO All About SAD 18
THREE How Seasonal Are You? 51
FOUR What Causes SAD? 61
FIVE SAD in Children and Adolescents 81
SIX “Summer SAD” and Other Seasonal Afflictions 95
Part II
Treatments
SEVEN Light Therapy 113
EIGHT Beyond Light Therapy: Other Ways to Help Yourself 166
NINE Psychotherapy and SAD 190
TEN Antidepressant Medications 209
ELEVEN A Step-by-Step Guide Through the Revolving Year 225
TWELVE “How Can I help?”: Advice for Family and Friends 247
Part III
Celebrating the Seasons
THIRTEEN A Brief History of Seasonal Time 255
FOURTEEN Polar Tales 260
FIFTEEN SAD Through the Ages 264
SIXTEEN Creating with the Seasons 275
SEVENTEEN Words of All Seasons 284
EIGHTEEN Winter Light: Life Beyond SAD 294
AFTERWORD The End of an Era, 1979-1999 307
Part IV
Resources
Where to Get Further Help for Seasonal Problems 311
Dietary Advice, Menus, and Recipes 315
Further Reading 341
APPENDIX A Daily Mood Log 347
APPENDIX B Core Belief Worksheet 349
Index 351
About the Author 372
Winter Blues Synopsis +
Winter isn’t a “wonderland” for everyone. Every year, millions of us feel our energy levels ebb and spirits fall as the days grow shorter. The condition is called seasonal affective disorder (SAD), and it can cause depression, reduce your productivity, and make it harder to control your appetite. In this no-nonsense, up-to-date survival kit for weathering the winter blues, Dr. Norman Rosenthal explains what causes seasonal mood swings and what you can do about them. A self-test allows you to evaluate your own level of SAD and helps you determine an appropriate plan of action. the book covers an expanded variety of methods proven to help you feel better – including new developments in light therapy, antidepressant medications, and breakthrough self-help strategies. Convenient menus and easy recipes make sticking to healthy winter diet more enjoyable, and a new section on the benefits of exercise motivates you to stay active even when it’s gloomy outside. A step-by-step guide helps you organize your yearly schedule to anticipate seasonal changes, and a special chapter for family and friends teaches loved ones effective ways to show support. Like a ray of light on an otherwise cloudy day, Dr. Rosenthal’s expertise, warmth, and enthusiasm will inspire you to reclaim the winter months and find ways to celebrate even the darkest days of the year.
Winter Blues Book Reviews +
“This is the book I recommend to all who struggle beneath the weight of winter. It is highly authoritative yet lively, warm, and quite personal. Dr. Rosenthal is an unsurpassed expert in the field and he lays out exactly what you need to do to feel more like your ‘summer self.’”
-Michael J. Norden, MD, Author of Beyond Prozac
“Dr. Rosenthal writes beautifully about the human side of the reasons and our profound beholdenness to light, while at the same time providing an invaluable guide to handling the seasonal depressions that affect so many individuals.”
- -Kay Redfield Jamison, PhD,
- author of An Unquiet Mind and Exuberance
“Read and Heed Dr. Rosenthal’s advice. It can change your life.”
-Jean Carper, Syndicated Columnist
Winter Blues: Publishing Details +
(c) 2006 Norman E. Rosenthal
Published by The Guilford Press
A Division of Guilford Publications, Inc.
72 Spring Street, New York, NY 10012
All rights reserved
Includes bibliographical references and index.
ISBN-10: 1-59385-116-2 ISBN-13: 978-1-59385-116-3 (pbk.)
ISBN-10: 1-59385-214-2 ISBN-13: 978-1-59385-214-6 (cloth)
1. Seasonal affective disorder-Popular works. I. Title.
RC545.R67 2006
616.85’27-dc22
** Bloggers writing about Transcendence or Winter Blues 4th edition please see the following links and information as inspiration and ease for your review or publication. If you have any comments or requests please leave them in the comments section below. **
September 3, 2012
A Sneak Peek at the 4th Edition of Winter Blues
Introduction to the Fourth Edition of Winter Blues
A “Landmark Book” gets a Major Update
Winter Blues has been called a “Landmark” book by the New York Times because over 100,000 readers have turned to the book for help in understanding their own unique responses to the shortening days of autumn and winter.
For that matter, all the different seasons may present challenges to different people. Winter Blues explains that all to the reader and has been a survivor’s manual for those struggling to cope with these seasonal changes.
The author, Norman E. Rosenthal, M.D., who described the syndrome and is the world’s leading expert in its treatment, has remained at the cutting edge of the field, and returns to update the reader on its development.
But why update a classic and what’s new about it?
In a word, lots.
The new version of the Winter Blues has become leaner. The author cut out a lot of literary and historical information that was originally designed to prove the case that SAD exists – a case that no longer needs to be made.
Everyone agrees that Winter Blues is here to stay. The reader wants to know how to recognize it, all the options available to treat it and, for those who are a little more curious, why some people are more likely to get it than others. All this is covered in the new Winter Blues.
The new version of the book is more reader-friendly than ever, with the help of chapter openers that tell readers what questions are answered in the chapter so they can zero in on the material they need when they need it. Likewise, pullout quotes have been provided to draw attention to important take-home facts and points, and boxes to highlight special material.
All new treatments have been updated. Many changes have been made to the section on light therapy and there are pictures of some of the latest boxes and devices for treating Seasonal Affective Disorder and the Winter Blues. All the latest research in SAD has been included and all sections have been updated since the last edition was published 6 years ago.
The most radical and perhaps interesting change in the new Winter Blues is an entire chapter on the use of meditation to treat the condition. Since the last edition of Winter Blues was published, Rosenthal has written the New York Times best-selling “Transcendence: Healing and Transformation Through Transcendental Meditation.” (Tarcher-Penguin, 2011). In the new version of Winter Blues, he presents case reports of individuals who have benefited from both Transcendental Meditation and Mindfulness Meditation. Rosenthal explains that one of the triggers for the Winter Blues is stress, and one of the best stress-relievers available is meditation. This chapter offers Winter Blues sufferers a brand new approach to dealing with their problems.
But Rosenthal has always emphasized eclecticism, so there is updated information about psychotherapy, medications and practically everything you can think of to help the Winter Blues – all packaged in a leaner and easier to read format than ever.
Additional Resources:
How to Beat Seasonal Affective Disorder and The Winter Blues [Infographic]
August 20, 2012
Upcoming Events
Dr. Norman Rosenthal – Upcoming Speaking Engagements
1) Chicago – 3 events in September
Sept 5: Gleacher Center, click here for full details.
Sept 6: Private at Loyola Stritch School of Medicine (Not open to public)
Sept 7: Chicago Lakeshore Hospital, click here for full details
*We are asking people who want to attend the Chicago Lakeshore Hospital event on Sept 7 to email Carla at Chicago@tm.org
2) Reddit AMAA (Ask Me Almost Anything) September 12th 2 hours in afternoon & 1 in the evening (2 to 4pm EST and again from 8 to 9pm EST)
3) University of Maryland on Sep 20th at 7pm – Stress, Meditation and Self-Healing: The Role of Transcendental Meditation in Prevention and Treatment of Disease
4) Webinar on Sep 27 – TM Health professionals, webinar with video from interview with Dr. Pamela Peeke
5) London in October:
Saturday 6 October 10:30am – 12:30pm
Guy’s Hospital, London SE1 9RT
“Light and Transcendence: Non-pharmacological approaches to stress and the winter blues”
Primarily for doctors and health professionals.
More information: www.maharishifoundation.org.uk/rosenthal-tour/guys-hospital.html
Saturday 6 October 2:00 – 5:00pm
Regent’s College, Regent’s Park, London NW1 4NS
“Winter Blues: Everything you need to know to beat Seasonal Affective Disorder”
For everyone with an interest in managing this condition.
More information: www.maharishifoundation.org.uk/rosenthal-tour/sada.html
Sunday 7 October 10:00am – 4:30pm
Regent’s College, Regent’s Park, London NW1 4NS
“Attaining and transcending good health: How transcendence can heal and transform mind and body – Ayurveda’s secret of healing, validated by modern medicine”
An interactive and practical day course with: Dr Norman Rosenthal and Dr Donn Brennan.
More information: www.maharishifoundation.org.uk/rosenthal-tour/rosenthal-brennan.html
Monday 8 October 1:30 – 4:00pm
London Business Forum, 1 Bartholomew Place, London EC1A 7HH “Meditate, Grow Rich, Lead by Example – Your Own Way”
For the business and leadership community.
More information: www.londonbusinessforum.com/events/transcendence
Monday 8 October 7pm
Alternatives, St James’s Church, 197 Piccadilly, London W1J 9LL “Healing Transcendence”
A talk for those interested in contemporary spirituality and personal development.
More information: www.alternatives.org.uk/Site/Talks.aspx
Tuesday 9 October 5:30-6:30pm
Watkins Books, 19-21 Cecil Court, London WC2N 4EZ “Transcendence: Healing and Transformation through Transcendental Meditation”
A talk by the author, Q & A, and book signing.
Free. Open to the public. No need to book.
Wednesday 10 October
World Mental Health Day, 10am – 5pm London E1 6AW
“Tackling stigma and promoting mental wellbeing”
An all-day conference for those involved with mental health, limited places available.
More information: www.maharishifoundation.org.uk/register-for-event.html
6) Join Dr. Norman in Dublin
Thursday 11 October 7:30pm
Clyde Court Hotel, Ballsbridge, Dublin 4
“Transcendence: Healing and Transformation through Transcendental Meditation”
More information: www.maharishifoundation.org.uk/rosenthal-tour/Dublin.html
7) 92nd St Y in NYC – Transforming Your Health and Your Life through the Joy of Transcendence, Norman E. Rosenthal, MD
Tue, October 30 at 6:30 pm
Understand the role of meditation in promoting cardiac health, reducing anxiety and depression, and recovering from drug and alcohol abuse. Discover how transcendental meditation changes brain functions to help people live longer, better and more creative lives.
Please feel free to inquire about all public events at the appropriate link or in the comments section below.
August 14, 2012
Your ADHD Child: What Can You Expect From Medications
Guest Bloggers:
In order to expand the variety of blogs available for my viewers, I plan to ask colleagues I respect to post their thoughts about topics that I think will be of interest to my readers.
For my first guest blog, I am delighted to introduce my son, Josh Rosenthal, M.D., who is an adult and child psychiatrist in Columbia, Maryland.
He writes about a common concern among parents of children with attention deficit hyperactivity disorder (ADHD) – to medicate or not to medicate?
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Your ADHD Child: What Can You Expect From Medications
Joshua Z. Rosenthal, M.D.*
Stacy, a charming and precocious 8-year-old, paced around my office and fiddled with the pens on my desk as her mother rattled off the list of what she hoped medications could do for her daughter.
“I just want her to be able to stay on task and finish her work, be better organized in the morning so that it doesn’t take forever for us to get out of the house, be able to sit still at the dinner table, listen when I’m trying to talk to her so that I don’t have to repeat things over and over before she registers what I’m saying.” Without missing a beat, the little girl—who up until that point appeared to be in her own world—chimed in, “Isn’t that a lot to ask from one pill?” I could see both points of view.
As a parent, you may not be surprised to hear that attention deficit disorder with hyperactivity, better known as ADHD, has 18 different characteristic symptoms. You probably know what most of them are but in case you want the whole list, they are shown in Table I below.
So much has been written, both pro and con, about the value of medications to bring these symptoms in check. How does a parent make sense of it all? This is how I see it as a child psychiatrist who treats many children with ADHD. For most of these children, it is difficult to get the best results without medications. The good news is that medications usually help and such side-effects as may occur are generally quite tolerable. The not such good news is that medications won’t solve all your child’s problems.
It’s easy to see how you might be skeptical that a pill could really bring many of your child’s problems under control – and your child might feel the same way. But the condition is so frustrating for both parents and children that mostly people are willing to give medications a try.
Although we don’t fully understand the causes of ADHD, some research suggests that people with the disorder may not have enough of two key neurotransmitters – dopamine and norepinephrine – firing in the prefrontal cortex (PFC), that part of the brain just behind the forehead. The PFC can be considered the CEO of the brain, which helps the brain focus on priorities and organize what needs to be done. When it is not working properly, the brain may seem like a disorganized committee in need of a chairman. Most of the medications we use to treat ADHD boost concentrations of the two key neurotransmitters in question. That brings the CEO on line and helps organize the committee to get tasks done.
To decide on the best course of treatment, I assess the child’s specific needs, keeping in mind what side-effects may be of greatest concern (see Table II below). I consider, for example:
* Age – if the child is young and has an early bedtime, I avoid medications that wear off too late and cause insomnia.
* Size – if the child is a picky eater and small for her age, I shy away from drugs that are likely to cause appetite suppression.
* The child’s homework schedule: Does it require a great deal of concentration in the evening or is daytime the most critical time for study?
All this, of course, requires close collaboration between parent, child and doctor. Once we have thought through the issues – goals, concerns, special considerations – we are ready to choose an appropriate medication.
Medications for ADHD are typically divided into stimulants and non-stimulants. Since stimulants are still the primary treatment, this discussion will focus on that class of drugs. Usually I start with a long-acting medication, such as Concerta, Vyvanse, or Adderall XR (See Table II below for list of medications—stimulants), in the morning before school, in the hope that it will last through the school day. Then, depending on what the evening schedule is like, I often recommend a second short-acting medication, such as Ritalin, Focalin, and Adderall (not XR) to help the child focus on evening activities, such as homework, or music lessons.
I tend to avoid using long-acting medications in the morning if the child is falling behind on the growth chart, preferring a shorter-acting medication, which will hopefully wear off in time for the child to have a good appetite at lunchtime. After lunch would be a good time for the child to get a second dose of medication from the nurse’s office to help with focus and concentration through the afternoon.
It is important to customize medication treatment according to each child’s needs and circumstances, with parent, child and doctor working together as a team.
One challenge with medication is getting children to take it in the first place. Swallowing pills is the number one reason that they object to medication. One way around this is that most drugs come in capsule form, which can be opened and poured into an easy-to-swallow food, like yogurt or pudding (Concerta is an exception in this regard).
If swallowing is an absolute impediment, I recommend a skin patch version of Ritalin, called Daytrana, that works just as well as the long-acting capsules. The challenge is remembering to take it off after 9 hours of use so that it doesn’t last too long and keep your child up at night.
Many children shy away from the idea of taking medications because they regard it as a stigma, which somehow brands them as being abnormal. To counter this, I tell them that I know many successful people, including doctors, lawyers, and engineers, who have gone far in life despite having the diagnosis of ADHD, because they were helped by their medication.
I reassure people that they can always stop the medications if they want to and encourage them to tell me if they are considering doing so. As a parent, you might think such a reassurance is a bad idea, but it emphasizes the importance of self-reliance and making good choices. And let’s face it; most children know they can stop anyway. By giving them permission, they are more likely to tell you if they do stop their medication, which allows for an open discussion of the subject, including benefits, side effects and general feelings about medication.
In addition to side effects, there can be other limitations to medication, as well. A child may experience improvement in some areas, such as symptoms of hyperactivity, but not in other areas, such as inattention. Sometimes, even with the best possible combination of long- and short-acting medication, it is hard to extend the effect long enough into the evening to address all problems without causing insomnia.
Then there is a problem that I refer to as successful pill, unsuccessful child. It is not uncommon for me to see parents come in with high hopes only to be disappointed when they don’t see the results. The child will report feeling more focused and the teachers will notice better participation, but their grades are still poor. Parents will say that they rarely see the child crack open a book. So what happened? Sometimes there could be another undiagnosed problem, such as depression or a learning disability. But often, the problem is that the medication worked but the child isn’t interested in trying. When I raise this issue with the child, a common response is, “well I’m passing.” Sometimes we forget that the pill and the child are two separate things. These experiences have taught me to routinely to tell parents that their child will get as much out of the treatment as they put into it—that the best piano teacher can only lead you as far as you are willing to work for results, and the same can be held true for the best pill.
In conclusion, let’s return to the question posed by Stacy at the top of the blog: “Isn’t that a lot to ask from a little pill?” I hope I have shown you that a little pill can go along way, but that people with ADHD need a lot of help from both parents and professionals if they are to fully realize their potential.
Table I: DSM-IV Diagnostic Criteria for Attention Deficit/Hyperactivity Disorder
A. Symptoms of inattention: Six or more of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
1. often fails to give close attention to details or makes careless
mistakes in schoolwork, work, or other activities;
2. often has difficulty sustaining attention in tasks or play activities;
3. often does not seem to listen when spoken to directly;
4. often does not follow through on instructions and fails to finish
schoolwork or chores (not due to oppositional behavior or failure to understand instructions);
5. often has difficulty organizing tasks or activities;
6. often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework);
7. often loses things necessary for tasks or activities (e.g. toys, school assignment);
8. is often easily distracted by extraneous stimuli;
9. is often forgetful in daily activities
B. Symptoms of hyperactivity-impulsivity: Six or more of the following symptoms of hyperactivityimpulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
1. often fidgets with hands or feet or squirms in seat;
2. often leaves seat in classroom or in other situations in which
remaining seated is expected;
3. often runs about or climbs excessively in situations in which it
is inappropriate;
4. often has difficulty playing or engaging in leisure activities
quietly;
5. is often “on the go” or often acts as if “driven by a motor”;
6. often talks excessively
7. often blurts out answers before questions have been completed;
8. often has difficulty awaiting turn;
9. often interrupts or intrudes on others (e.g., butts into conversations or games).
In addition to the above behavioral criteria, the student must (1) d isplay hyperactive-impulsive or
inattentive symptoms severe enough to cause impairment prior to the age of 7 years; (2) display
impairment from symptoms in two or more settings (e.g., school and home); (3) must demonstrate clinically significant impairment in social or academic functioning; and (4) not have another disorder that can account for the behavioral symptoms.
Source: American Psychiatric Association. (1994). Diagnostic and statistical manual of mental
disorders (4th ed.). Washington, DC: Author.
Table II: Stimulant Medications for ADHD
Class
Drug Name
Form
Duration
Amphetamine Stimulants
Adderall
Short-acting
4-6 hours
Dexedrine
Short-acting
4-6 hours
Dextrostat
Short-acting
4-6 hours
Dexedrine
Spansule
Long-acting
6-8 hours
Adderall XR
Long-acting
8-12 hours
Vyvanse
Long-acting
(prodrug)
10-12 hours
Methylphenidate Stimulants
Focalin
Short-acting
4-6 hours
Methylin
Short-acting
3-4 hours
Ritalin
Short-acting
3-4 hours
Metadate ER
Intermediate-acting
6-8 hours
Methylin ER
Intermediate-acting
6-8 hours
Ritalin SR
Intermediate-acting
4-8 hours
Metadate CD
Intermediate-acting
8-10 hours
Ritalin LA
Intermediate-acting
8-10 hours
Concerta
Long-acting
10-12 hours
Focalin XR
Long-acting
6-10 hours
Daytrana patch
Long-acting
10-12 hour
Common Side Effects: loss of appetite, weight loss, insomnia, irritability, tics, increased anxiety, jitteriness, or paradoxically feeling slowed down (zombie-like). Longer acting medications might lead to more pronounced appetite suppression or insomnia.
* Joshua Z. Rosenthal, M.D. is a child and adult psychiatrist, practicing in Columbia, Maryland. He can be reached via his web site at http://joshrosenthalmd.com.
July 27, 2012
A Sneak Peek at the Paperback Version of Transcendence
I wrote Transcendence: Healing and Transformation Through Transcendental Meditation (Tarcher-Penguin,2011) because I simply had to. Transcendental Meditation (TM) had done so much good both for my patients and myself, had such strong research backing, and was so pleasant and easy to do that I felt the urge to share these experiences as seen through the eyes of a doctor, scientist and TM practitioner.
One question I often like to ask people is, “What surprised you about it?” where “it” is whatever we happen to be discussing. In that same spirit, it seems reasonable to ask myself, “What surprised me about how Transcendence turned out?” Well, lots of things:
1. There was a terrific yearning for a straight-forward book that described Transcendental Meditation from several points of view: personal, clinical and scientific. That yearning led to Transcendence becoming a New York Times best-seller.
2. Transcendence was acclaimed by highly respected people and sources. For example, I have enormous regard for Mehmet Oz, one of the most distinguished physicians in the country, and was thrilled when he offered to write a foreword to the book. Transcendence also garnered a silver medal in the 2012 Nautilus Awards, which are given for books dealing with mind, body and spirit.
3. Insofar as I wanted to see others reaping the rewards of TM, the book was a great success. Teachers from all over the U.S. shared with me that the numbers of those interested in learning the technique have increased since the book’s publication and that many come to learn, book in hand.
4. As a scientist, I am impressed by statistics, but as a human being, I love a good story – and there were many about Transcendence over the past year. My insurance salesman, for example, asked what I was up to. When I told him, he bought the book, learned the technique and reported a transforming effect on his life – all within a few months. A highly respected psychiatric colleague with whom I shared my enthusiasm about TM was unpersuaded by my verbal reports – until he read the book. Then, in short order, he learned, felt wonderful, persuaded his partner to learn (they now meditate together every day) and referred many of his patients for TM instructions.
5. My experience with Transcendence has renewed my faith in the power of the written word. Even in a world so full of tweets, texts and Facebook posts, books still matter. What a wonderful discovery!
New York Times Best Seller “Transcendence” [Video 2:43]
So, what’s new about the paperback version of Transcendence?
In this regard, I was once again surprised – by all the developments in the world of TM just in the one year since Transcendence was published. I summarize these changes in a totally new chapter, called “After Transcendence.” Here are some of the highlights of that chapter:
1. Other groups not mentioned in the hardcover version who might benefit from TM include people with:
• Insomnia
• Migraines and other pain syndromes
• Tics, tremors and movement disorders
• Seasonal affective disorder and the Winter Blues
• Food addictions
• Autism spectrum disorder
I provide gripping stories of people in all these categories, as well as explanations for how TM might help such a widely divergent group of conditions.
2. Embracing Transcendental Meditation in business and athletics
Businesses are seeking out TM for their personnel as a way of boosting performance and promoting leadership. It is likely that the brain coherence that occurs when people practice TM is responsible for greater clear-headedness and improved decision-making. The relief of stress helps people remain cool-headed and thoughtful, both critical qualities for people in the high-pressure worlds of business world and athletics.
3. A caveat and a promise
The hardcover version of Transcendence contained so many descriptions of people who had dramatic experiences during meditation that I wanted to reassure those who did not have these four-star special effects that they could still derive tremendous benefits from the practice. Here’s how I end the new chapter.
For most people . . . myself included, the effects of TM are subtle and gradual, but cumulative. Yet as the rippling waters of a stream can smooth the edges of the sharpest stone, so can the gentle flow of meditation alter the shape and contours of a person’s life.
I hope that you enjoy the paperback version of Transcendence, and most of all, that you benefit from its contents.
Wishing you Light and Transcendence,
Norman
A Sneak Peak at the Paperback Version of Transcendence
I wrote Transcendence: Healing and Transformation Through Transcendental Meditation (Tarcher-Penguin,2011) because I simply had to. Transcendental Meditation (TM) had done so much good both for my patients and myself, had such strong research backing, and was so pleasant and easy to do that I felt the urge to share these experiences as seen through the eyes of a doctor, scientist and TM practitioner.
One question I often like to ask people is, “What surprised you about it?” where “it” is whatever we happen to be discussing. In that same spirit, it seems reasonable to ask myself, “What surprised me about how Transcendence turned out?” Well, lots of things:
1. There was a terrific yearning for a straight-forward book that described Transcendental Meditation from several points of view: personal, clinical and scientific. That yearning led to Transcendence becoming a New York Times best-seller.
2. Transcendence was acclaimed by highly respected people and sources. For example, I have enormous regard for Mehmet Oz, one of the most distinguished physicians in the country, and was thrilled when he offered to write a foreword to the book. Transcendence also garnered a silver medal in the 2012 Nautilus Awards, which are given for books dealing with mind, body and spirit.
3. Insofar as I wanted to see others reaping the rewards of TM, the book was a great success. Teachers from all over the U.S. shared with me that the numbers of those interested in learning the technique have increased since the book’s publication and that many come to learn, book in hand.
4. As a scientist, I am impressed by statistics, but as a human being, I love a good story – and there were many about Transcendence over the past year. My insurance salesman, for example, asked what I was up to. When I told him, he bought the book, learned the technique and reported a transforming effect on his life – all within a few months. A highly respected psychiatric colleague with whom I shared my enthusiasm about TM was unpersuaded by my verbal reports – until he read the book. Then, in short order, he learned, felt wonderful, persuaded his partner to learn (they now meditate together every day) and referred many of his patients for TM instructions.
5. My experience with Transcendence has renewed my faith in the power of the written word. Even in a world so full of tweets, texts and Facebook posts, books still matter. What a wonderful discovery!
New York Times Best Seller “Transcendence” [Video 2:43]
So, what’s new about the paperback version of Transcendence?
In this regard, I was once again surprised – by all the developments in the world of TM just in the one year since Transcendence was published. I summarize these changes in a totally new chapter, called “After Transcendence.” Here are some of the highlights of that chapter:
1. Other groups not mentioned in the hardcover version who might benefit from TM include people with:
• Insomnia
• Migraines and other pain syndromes
• Tics, tremors and movement disorders
• Seasonal affective disorder and the Winter Blues
• Food addictions
• Autism spectrum disorder
I provide gripping stories of people in all these categories, as well as explanations for how TM might help such a widely divergent group of conditions.
2. Embracing Transcendental Meditation in business and athletics
Businesses are seeking out TM for their personnel as a way of boosting performance and promoting leadership. It is likely that the brain coherence that occurs when people practice TM is responsible for greater clear-headedness and improved decision-making. The relief of stress helps people remain cool-headed and thoughtful, both critical qualities for people in the high-pressure worlds of business world and athletics.
3. A caveat and a promise
The hardcover version of Transcendence contained so many descriptions of people who had dramatic experiences during meditation that I wanted to reassure those who did not have these four-star special effects that they could still derive tremendous benefits from the practice. Here’s how I end the new chapter.
For most people . . . myself included, the effects of TM are subtle and gradual, but cumulative. Yet as the rippling waters of a stream can smooth the edges of the sharpest stone, so can the gentle flow of meditation alter the shape and contours of a person’s life.
I hope that you enjoy the paperback version of Transcendence, and most of all, that you benefit from its contents.
Wishing you Light and Transcendence,
Norman
July 26, 2012
Summertime: And the Living Aint Easy
I have on my bookshelf a small volume, published in 1879, called “The Summer and its Diseases,” by James C. Wilson, M.D., then of the Medical College in Philadelphia. The good doctor notes wisely in the foreword that:
“Man, born to sorrow as the sparks fly upwards, finds some pain in every pleasure, some sadness in all joy, some fear in every hope. The changing seasons remind him that the seed is not quickened except to die, and each one brings to him, as it comes with its many blessings, some new suffering and sickness.”
As a physician who has studied the effects of the seasons on human beings for years, I agree with Dr. Wilson. But as a psychiatrist, I see different types of afflictions that those listed his book, which include sunstroke, dysentery, cholera, fevers, allergies and skin problems. Instead, I see summer depression, mania, anger problems and, of all things, winter- seasonal affective disorder in summer. Here is a quick round-up of these maladies.
Summer Depression (Summer-Seasonal Affective Disorder)
Shortly after we identified Winter-SAD, my colleagues and I identified a summer version of the condition, in which people become depressed as the days get longer and hotter, and feel better in the winter. We still don’t know why the summer triggers depressions regularly in some people – perhaps it’s the intense heat or maybe too much light. People with this type of depression often have symptoms that are different from those with Winter-SAD. They often lose appetite, sleep and weight, and are agitated rather than lethargic – all opposite to the typical symptoms of Winter-SAD. In some ways the summer-SAD is more dangerous than the winter version because those who suffer this malady are more likely to feel suicidal (which may go along with their feelings of agitation). Although it may be helpful to avoid heat (for example, by staying in air-conditioned rooms) and too much light (for example, wearing wrap-around dark glasses), the mainstay of treatment is starting antidepressant medications early and staying ahead of the curve as the summer progresses, thereby preventing the depression from deepening. Needless to say, this necessarily involves getting a qualified professional on board.
People with bipolar disorder tend to have problems with being over activated, irritable and angry in the summer. Although many people think of mania as a state of excessive elation and exuberance – which may occur – that is often not the case. The agitation, restlessness and sleep loss that occur with hypomania (a less severe form of mania) often come along with a short fuse and a bad temper – or suppressed anger in those able to restrain themselves.
Again, avoiding intense light is a key form of treatment (short of medication, which may also be necessary). Once again, this can be accomplished by dark glasses, along with avoiding light in the early morning and late evening. Blackout curtains may be helpful to prevent the rays of dawn from waking people too early; and dimming indoor lights (no more than one 60-watt bedside lamp and no bright computer screens) after 9 PM may also be helpful.
Winter-SAD in Summertime
This summer has introduced me to a form of summer distress that I had not previously considered – Winter SAD in summer – an apparent paradox, which I first encountered when Miranda, a long-standing patient of mine, stopped by for a routine office visit.
Miranda is a professional in her mid-fifties, who has suffered for many years from typical seasonal affective disorder (SAD) between October and March. Since it is now high summer, I expected her to be doing well, but I was wrong. She complained of all the typical symptoms of her winter depressions: glum mood, low energy, a desire to curl up on her couch in front of the TV, and a serious case of the munchies – “everything that isn’t nailed down,” as she put it. To make matters worse, she said, although she expects to feel this way in the winter and has a whole regimen in place for dealing with her winter SAD symptoms, but she was utterly unprepared for them at this time of year when she typically feels at her best.
“What could be going on?” We both wondered.
Now, I have certainly seen winter SAD occur in summer or at any time of year when the weather is unseasonably foul. That’s how many people with SAD must be feeling in London, where they have been having one of the rainiest summers in living memory. That and all the unpleasantness of having the Olympic Games in one’s back yard is causing many Britons to complain much more than usual, according to a recent article in the New York Times.
Here in the United States, however, we are having one of the hottest summers on record with blazing cloudless skies. So, why should anyone be developing SAD? As I thought about the matter and discussed it with Miranda, the reason became clear. Miranda could not tolerate the hot days, so she was spending her time mainly indoors out of the sunlight. To make matters worse, she was keeping the blinds drawn so as not put too much strain on the air conditioning system. In other words, she was creating winter lighting conditions in mid-summer. To test this theory, I suggested that Miranda use light therapy each morning as she does in the winter, though not for as long (10-15 minutes instead of 30-45 minutes). It worked, and within a few days, Miranda felt her happy summer self again. She plans to keep using the lights until outdoor temperatures settle down and she is able to get outdoors again.
Bottom line for those of you with winter-SAD: It is not simply a winter condition: It is a light-deficiency condition. Any time the light levels fall too low – even in midsummer – you are at risk for symptoms.
Wishing you Light and Transcendence,
Norman
Additional Articles on this Topic:
Seven Tell-Tale Signs of Depression in a Friend or Loved One
How to Beat Seasonal Affective Disorder and The Winter Blues [Infographic]
On the Frontiers of SAD: How Much Light is Enough?
Traveling to the Sun: The Ultimate Rescue Cure for the Winter Blues
